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  • AADD Moderators: swilow | Vagabond696

⫸STICKY⫷ Australian Opiate Withdrawal Maintainance Medication Prescribers

Cheers trayel, its so hard and ive been trying to get clean for the past 3 weeks going on to the 4th weeks. I have to return back to work soon ams honestly I haven't tried that hard. But now the realisation of my limited time has hit me and I need to really knuckle down. Does anyone know if someone begins getting withdrawals symptoms and then take a little bit of naltrexzone would that speed up the withdrawal progress?

I found an interesting article relevant to your question about naltrexone, or naloxone in this instance, "speeding up" or making the withdrawal process a little less shit.

Continuous naloxone administration suppresses opiate withdrawal symptoms in human opiate addicts during detoxification treatment.

In a small clinical trial, a new therapeutic approach was studied, whether naloxone, in high dosage over a prolonged period of time, will attenuate withdrawal symptoms in acute opiate detoxification. Six opiate addicts, satisfying DSM III-R criteria of opiate dependence, were given 10 mg naloxone under short barbiturate anaesthesia, followed by repeated doses of 0.4 mg/h naloxone for at least 72 h. Acute onset of withdrawal symptoms brought about a high dose of naloxone could be suppressed by the short barbiturate anaesthetic; neither continuous supply nor cessation of the naloxone regimen after 96 h caused any severe withdrawal symptoms. Morphine and naloxone measurements in blood at the start of naloxone therapy enabled pharmacokinetic explanations for this paradoxical action of naloxone to be excluded.

Continuous naloxone administration suppresses opiate withdrawal symptoms in human opiate addicts during detoxification treatment.

Ash. <3
 
The only problem is that I don't have access to naloxone I only have naltrexzone at my disposal and I took a quarter of a pill the other week. It got really bad that ambos were called. So there is no way I'm putting my parents through that pain again. I guess the only way is to drop my habit to a point a day n just cold turkey it.
 
Anyone know if there is much truth in Optimal dose?, Lately i been taking a lot of benzo's daily, I never used to but i am find stress levels intolerable, that or I should increase a higher dose. thanks.
 
I think people should be allowed to live their lives however they see fit. You only get 1 chance and it should be enjoyed. Now if your addiction is having major health and negative effects on you and the people around you then professional help is needed.

Methadone/Suboxone/Subutex are just substitutes that the State benefits from financially and IMO those drugs are way harder and more damaging to the body than say pure opiates like Codeine. They keep the patient on longer and longer so they gain revenue from the 'addict' Look what is going on in American, it's disgusting.

I know those liquid handcuffs are hard to break, what do you do though?
 
Anyone know if there is much truth in Optimal dose?, Lately i been taking a lot of benzo's daily, I never used to but i am find stress levels intolerable, that or I should increase a higher dose. thanks.

The maximum dosage of 32mg is most definitely a fact! The drug itself is as follows....

{Sorry, I assume you meant the optimal dose for Bupe? My bad otherwise. Please further :) }

And a number of things for you to take note of Methadonia;

1. Daily benzo use (to generalise), you will find your tolerance will increase dramatically after 1.5 weeks (drug profiles will provided different results of course). Benzos - definitely in the medical profession and many people would agree on BL, is not the long term answer. It is a quick fix, in times of extreme anxiety/depression. You're best option would be to make an appointment with an psychiatrist/psychologist which will help you through and provide techniques on how to handle the stress in your life*.

2. By using your handle, I'm assuming you're on a methadone ORT? If possible transfer try to be transferred to a Suboxone program (you'll get your fans and "boos" from this site regarding each. But in my personal, professional and educational experience, this will be a lot easier to cope with. Although you say something about a maximum dose of 32mg? That will be Suboxone/Subutex (Buprenorphone with or without Naloxone). It is not a myth that Buprenorphine has a maximum dose of 32mg! Anyone knowing anything about drug kinetics can easily workout Vmax IS 32mg, you will not feel any additional euphoria, analgesia or reduced cravings with a dose higher than this! ** So essentially raising the Bupe dose will not again any addition effect ***

If you've just started on ORT and 32mg isn't enough, go back to your councilor, be straightforward and they will arrange something - trust me, the will prefer to organise something than risk you going back onto streets (or however you're obtaining your opiates) and endangering so many lives.


If you have any questions, feel free to reply here or PM me. Always happy to help! %)



* I realise I'm over-simplifying things here. Don't get me wrong, I am fully aware of how crippling severe stress and anxiety can have on all aspects of ones life. This is just a suggested start.

** I can go into the pharmacodynamics/-kinetics (essentially how the body reacts with the drugs / how the drug reacts with the body) if you like? I just don't want to scare you off with all this (bio)chemistry if it isn't warranted! :)

*** Depending on the formula you have there, most Sub preparations do have Naloxone in them to prevent the IV'ing of the Bupe. Other than IV (which the narc will negate any effects), sub-lingual (under the tongue) will yield the highest bio-availability (read: the highest amount absorbed into your body!) - so just don't try it and I most definitely do not condone it! (just saving my ass!)
 
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....There are no medications that will alleviate opiate-detox symptoms other than more opiates. Sure, benzos help the racing thoughts, and atypical anti-psychotics help you sleep long and deep, and all the other stuff for physical symptoms will ease physical discomfort....

Yes and no. Primarily as of the last few years the standard has to put someone on ORT (Opiate Replace Therapy) which does involved replacing a much more destructive opiates - di-morphine (Heroin), Morphine, Oxycodone - with an opiate with a lesser destructive drug profile. Primarily Buprenorphine (in Suboxone [the most common due to the incorporation of Nalxone to primary prevent ROA diversion > IV) or Subutex which is minus the Nalaoxone but only in special cases (pregnancy, intolerance, etc). Second to that is Methadone however this is becoming less and less prescribe (in the first case) do to it's greater abuse potential (eg, no ceiling dose).

Other than these, opiate w/d 's are usually treated symptomatically. That is, drugs to reduced hypertension, asthaesia, anxiety, depression, etc. You are right Willy in the atypical anti-psychotics are readily prescribes however don't let the fact that they're "anti-psychotics" put you off, they can be quite helpful!.


....I once decided to go through a cold-turkey detox, just to see what it was like....

Good fine (re: the paper) Willy!

I say good luck to ya mate! You're a brave man. There can be serious side-effects from doing this essentially what's called PAWS - Post-acute withdrawal syndrome which is basically just a fancy term for a catch all symptoms including; sweat palms, mood swings, anxiety/depression, cognitive impairment, febrile, MI's (heart attacks or angina), to death {to name a few}. However there are way too many variables to even begin suggesting where to begin. Hence why most people go with ORT.


I found an interesting article relevant to your question about naltrexone, or naloxone in this instance, "speeding up" or making the withdrawal process a little less shit.....Continuous naloxone administration suppresses opiate withdrawal symptoms in human opiate addicts during detoxification treatment.....

Naltrexone has showed promised as a treatment for opiate dependance. The main issue in most studies in non-compliance.
Naltrexone has been used off-label for many things, although not many studies really have been concluded to give a definite answer in the treatment of opiate addiction unfortunately.* The main reason for Naltrexone as ORT (and in fact replace medication for many other non-opiate based addictions) is that it's believed to play a role in the modulation of a (Nucleus acumbins > Ventral Tegmental pathway, a Mesolimbic pathway) dopaminergic pathway in the brain which amongst other roles plays a huge part in the body's own reward system. That is, you take a drug (which influences this pathway), it causes an efflux of dopamine which the boy interpreters as good/happy/love which can ultimately lead to addiction (since of course everyone wants to feel happy! =D )

Just fyi; naltrexone and naloxone are different drugs. They both are opiate (to different sub-affinities) antagonist however they do not do the same thing - don't get them mixed up!



* Word of warning, do not use naloxone to try to reverse an opiate OD. It will not work! Although working on similar receptors, they have differentiate mechanisms of actions!
 
Regarding take aways: from memory it depends on the 3 things, legislation, your attitude, demeanor to your GP and your demeanor to the Pharmacists - all three can refuse providing take aways for a variety of reasons (regardless or what the prescription says!!). For instance, if you come into your GP/Pharmacist looking deshabbled, unkept, unshowered, (possibly) on the effects of other substances, these are all reasons (but not limited to) refusing you take aways!

Essentially, try to get your life back on track, keep yourself neat and tidy, shower(!!!! 8) ), be polite. Ultimately you don't have to be your GP/Pharmacists best friends, but treat them with respect and as long as your scripts says you're available for take aways, there should be no reason why not.

I know in SA the laws states (and don't know why it should be any different anywhere else considering the DAA department which issue authorization numbers for clinicians to prescribes these things is a national department, so not quite sure why the little details are left up to state legislation) Oh well.... that you are able to take two take aways per week or four per fortnight (don't quote me on these. I'll check my papers later). However you will work this out with your Pharmacist!

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Regardling tapering;* the general consensus is 2mg / day until you're all out. How ever from the DAASA themselves > National Clinical uidelines and Procedures for the Use of Buprenorphine in the Treatment of Opioid Dependence - page 46 is what you're after. Although the entire document is extremely interesting (imo lol).

* Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction.
* A comparison of buprenorphine taper outcomes between prescription opioid and heroin users.
* Buprenorphine tapering schedule and illicit opioid use.
* A comparison of buprenorphine taper outcomes between prescription opioid and heroin users.

A few supporting experiments. If you don't have access to the full article, let me know. (please don't just read the abstract, they can be deceiving!)

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Just thinking about about drugs to mitigate opiate w/d's, if anyone's interested post here. I'll list a few with are specifically indicated (some Rx, some OTC).





* I have to say this, but you should really titrate your dose under the supervision of a medical professional!
 
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Just fyi; naltrexone and naloxone are different drugs. They both are opiate (to different sub-affinities) antagonist however they do not do the same thing - don't get them mixed up!

* Word of warning, do not use naloxone to try to reverse an opiate OD. It will not work! Although working on similar receptors, they have differentiate mechanisms of actions!

Not getting them mixed up is a good suggestion ... but then it looks like you went on to immediately mix them up. Naloxone is the main treatment for opioid ODs.
 
Not getting them mixed up is a good suggestion ... but then it looks like you went on to immediately mix them up. Naloxone is the main treatment for opioid ODs.

Exactly!!! Naloxone is also known as Narcan and is what the ambos dose you with if you drop.

Incidentally - there are a couple of projects underway in Australia to make naloxone more widely available. In other countries the people who are actually using heroin and other opiates can also get naloxone so they can give it to their friends in the event of an overdose - or be dosed if they drop themselves. It's a bit like having an epi-pen if you are at risk of experiencing anaphylaxis.

CAHMA is running a project in Canberra, and it looks like a few might start up in Melbourne very soon. Already any GP can prescribe naloxone minijets - it's essentially 400um naloxone in a vial that can be drawn into a syringe for IM injection. It's on the PBS now so $5.60 for 4 doses for health care card holders and about $36 full price.
 
....Incidentally - there are a couple of projects underway in Australia to make naloxone more widely available....

Hmm, I was not aware of this, very interesting! Do you have any info you could send to me ayjay regarding this?

....Already any GP can prescribe naloxone minijets....

While I am all full the increased availability of these (they do save lives!), I'm surprised a physician would prescribed/encourage their use. First and fore most the physician should really be pushing the pt to enter a clinic for ORT (and/or explaining all the negatives associated with an opiate addiction and support discontinued use).

:\ I guess even for all that not all (most?) people wouldn't listen. And if the pt flat-out states they're going to continue using than.....
 
Hi there, sorry for your relapse but I think I can help. If you can follow my thread and instructions on how I beat H and all other opiates in 7 days, I'm sure you will be happy with the out come in 7 days. Trust me this is not a gimmick or a joke, it Gods honest truth. I have gone 17 days now clean and only taking iboprofen for the ache now and then, sertraline for any depression and vallium if I feel the devil calling. Let me know if it helps.

http://www.bluelight.ru/vb/threads/...lmost-ZERO-withdrawl!?p=11851615#post11851615
 
Hmm, I was not aware of this, very interesting! Do you have any info you could send to me ayjay regarding this?



While I am all full the increased availability of these (they do save lives!), I'm surprised a physician would prescribed/encourage their use. First and fore most the physician should really be pushing the pt to enter a clinic for ORT (and/or explaining all the negatives associated with an opiate addiction and support discontinued use).

:\ I guess even for all that not all (most?) people wouldn't listen. And if the pt flat-out states they're going to continue using than.....

Like I said CAHMA is running a peer naloxone project

And it's a harm reduction initiative, so not really about telling people that they should stop/cut down drug use. I would hope that GPs can come to terms with the harm reduction approach - but of course some won't.
 
Here's my situation .. After a week or so of dabbling I found myself back in the shit.to get through To the next shot (usually 1per week these days) i buy Suboxone strips and smoke them.. I'm finding this stupid due to having to be uncomfortable for 2-3days before pay day to feel the gear..and even then it's mediocre . Also street subs arn cheap..If I get methadone a bang it and I'm sick 12hrs later. Seems I've still got a junkie mentality and sub concheslly don't really want to give up the weekend tickle.I don't want to draw this out anymore.
I don't want to end up on methadone for the rest of my life and think getting my own Suboxone script with no takeaways due to the smoking aspect (it's a bad habit and hard to give up..hate the taste when taken sublingually..) is the way to go.. Fast taper off and no scoring for like a month after last dose? I can smoke 2mg and holds me for 2 days but have smoked 16mg before. Not a massive habit ..also have a girlfriend that's in same boat.
So yeah ..any suggestions or tips would be appreciated.

Or should I just go bush for a month like the last time this happened?(<- last resort)

Also anyone else try and smoke Suboxone?

Cheers guys.
Ps sorry on the shabs
 
Just need to point out that from a HR perspective smoking subs is a really bad idea, you really have no idea what kind of by products you are inhaling from both the heating of pill binders and buprenorphine. I understand it may be cost effective but you should consider your health as well, we certainly cannot encourage pill smoking as a safe or healthy way for people to ingest their drugs as this is a harm reduction focused website.
 
First off, even for the fact that you're contemplating getting off the gear is good, 5ativ4, well done!

I agree with d_m however, smoking like this is not safe (although this shouldn't come as such a surprise, I shouldn't think)

I have read quite a number of negative comments regarding going on ORT, especially Bupe (Suboxone/Subutex) - although there are definitely an overwhelmingly greater number of positive opinions than negative!

SL (Sub-lingual [under the tongue]) really is the best way to absorb Buprenorphine (pharmacologically it has the highest bio-availability than any other ROA). IMO if one were to list the pharmacological profile of Bupe, compared with Methadone (or any other opiate in fact), as ORT it really is the best! V. long half life, high enough BA, partial agonist/antagonist at different receptors (say vs. full agonism at mu), reduced/low possibility of abuse potential (especially the Suboxone - Bupe + Nalox - variation), etc, etc.

....I don't want to end up on methadone for the rest of my life....

This is a normal worry for any ORT. Typically (although it is dependant on each individual's circumstance and each place) during your work-up you're given the option of sort of like a "quick detox" where you stay in their apartments/place, dosing is monitored and titrated down over the course of two (or so) weeks, or (and this I think is the most common. Especially for those with a long-term addiction) you're dosage is sorted out (usually over a week. They'll start you on the "minimum" and keep upping the dose until you're at a comfortable place - not getting high every time but enough to stop cravings and etc.) and you can then be handed over to your (or a) local GP (you'll have to find a GP and Pharmacy which will dispense [not all do it], although they usually help with this too!) - who will take over your prescription and you just go into (which ever) Pharmacy to collect (where you'll be - or should be - watched dosing just so you don't subvert [and go and sell it or something]).

5ativ4, take the first step! Having your gf with you (in the same program possibly?) would also help with support. The drug itself is just a (small) part of any addiction. If you have any question definitely feel free to either ask here or PM me or d_m (someone knowledgeable in the field :) ). There's no stupid questions!! =D
 
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Just need to point out that from a HR perspective smoking subs is a really bad idea, you really have no idea what kind of by products you are inhaling from both the heating of pill binders and buprenorphine. I understand it may be cost effective but you should consider your health as well, we certainly cannot encourage pill smoking as a safe or healthy way for people to ingest their drugs as this is a harm reduction focused website.

I probably have a different definition of harm reduction. I would say that if someone proposes to ingest a particular substance in a particular way, the harm reduction-inspired response is to determine what the potential harms are from that proposal, investigate the options for reducing said harms and then provide all that information in full so people can make an informed choice.

Now in terms of smoking suboxone, it is a tricky task to determine harms. I know it is done - certainly it is common enough in Australian prisons. The tiny amounts that people are getting to smoke while they are inside probably reduces the potential harms from inhaling whatever you get when you heat maize starch (the main binder). And it's certainly better than injecting while in prison - no clean fits! The best harm reduction advice is - it's safer to take as intended, but if you do smoke it, be aware that it is probably harming you. Pay attention to any symptoms such as sore throat, difficulty breathing, chest pain, wheezing etc. And there's a research projecy for anyone with the time and inclination around potential harms from smoking.

The additional factor to consider now is that the Suboxone sublingual tablets are off the market as of August this year, so if you're not on the film you soon will be as stocks of the tablets will dry up. Smoking the film is probably a bad idea too - but that won't stop people from trying. On the upside, if you have access to new injecting equipment it's certainly safer to inject than the tablets. But again the safest option is to take sublingually as intended.
 
who will take over your prescription and you just go into (which ever) Pharmacy to collect (where you'll be - or should be - watched dosing just so you don't subvert [and go and sell it or something]).

Just wanted to say: be nice to your pharmacist, and they'll be nice to you. I work, and having to stay there while it dissolves is a pain, etc. If you're polite, nice, and basically not acting like a junkie, they'll bend rules to help you out. That said, I'm apparently a Model Student for this (I've not missed a dose in over 12 months now, have pissed clean every time, and honestly I've not taken any opiates since I started, yay), but I know that the other regulars where I go who are nice and friendly get the same treatment.

The pharmacists make not much money from this, and I thank them for it. I figure its the least I can do to be polite :) [also, a cute one at my new pharmacy has a crush on me; I assume that it'd be bad ethically to go there, such a shame]
 
I personally don't think hooking up with an employee at a pharmacy you go to is wrong at all mate. If there is a mutual attraction between both of you don't let ridiculous social 'norms' sway you.
 
Just wanted to say: be nice to your pharmacist, and they'll be nice to you. I work, and having to stay there while it dissolves is a pain, etc. If you're polite, nice, and basically not acting like a junkie, they'll bend rules to help you out.....

+++1 C_T - very good advice! Other than there's no excuse for being a prick to someone anyway, watching someone dose isn't exactly the pharmacist highlight of their day! Additionally - although still within legal boundaries - building a good rapport with your local pharmacist will only benefit you in the long run! Personally I've been in situations (albeit not often) whereby a huge amount of bills had came in that week and I was allowed to have my account in areares for a week or two!

.....The pharmacists make not much money from this, and I thank them for it. I figure its the least I can do to be polite :) [also, a cute one at my new pharmacy has a crush on me; I assume that it'd be bad ethically to go there, such a shame

Correct me if I'm wrong but as far as I knew, the pharmacies don't actually even pay for the ORT drugs (they're covered by federal DDU). The payment one pays to the pharmacy is for time, taking the pharmacist away from other work.


I personally don't think hooking up with an employee at a pharmacy you go to is wrong at all mate. If there is a mutual attraction between both of you don't let ridiculous social 'norms' sway you.

Agreed. As long as the relationship isn't as a means for greater access to drugs (definitely not implying that this is your case!!), its mutual attraction, than go for it bud! :)


Not getting them mixed up is a good suggestion ... but then it looks like you went on to immediately mix them up. Naloxone is the main treatment for opioid ODs.

Well that's embarrassing! Lol. My bad! Thanks for the correction shoo-bop! :)
 
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